Friday, March 11, 2011

Physicians and NPs Stake Claims on Medical Home Lead

Four primary care medical societies recently released guidelines for accrediting patient-centered medical homes that would prohibit nurse practitioners (NPs) from taking the lead in this new model for delivering care, says a Medscape Medical News article.

Groups that currently accredit or recognize practices as medical homes are the National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC, formerly known as the Utilization Review Accreditation Commission. The Joint Commission plans to unveil a similar program later this year.

The physicians' societies are urging these groups to incorporate a set of medical home principles adopted by the 4 primary care societies in 2007. A principle in the guidelines that physicians should lead the medical home team of clinicians is a point of controversy because NPs also aspire to direct such teams, the article says.

The Accreditation Association for Ambulatory Health Care agrees with the primary care medical societies. It specifies that an accredited medical home is physician-directed. In contrast, the National Committee for Quality Assurance announced last fall that it would recognize nurse-led practices as medical homes in states that license NPs as independent practitioners. By defining medical homes as "clinician-led," URAC also leaves the door open to nurses being in charge, according to Jan Towers, NP, PhD, director of health policy for the American Academy of Nurse Practitioners, who adds that the medical home's emphasis on continuous, coordinated, and comprehensive care is "what nurses do routinely."

Responding to Towers, the American Academy of Family Physicians' says that physicians "are uniquely trained, comprehensively oriented, and prepared best to be the leader and coordinator of the patient-centered medical home."